MEDICARE: CLARA LYNN HARVEY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	27052	FL

General Provider Information

NPI Number	:	1346970738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARA LYNN HARVEY DMD

Provider Business Mailing Address
First Line	:	7517 SMOKEY RD
Second Line	:
City	:	GLEN SAINT MARY
State	:	FL
Zip	:	32040-5318
Country	:	US
Telephone Number	:	904-631-4535
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 SW MAIN BLVD
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-7050
Country	:	US
Telephone Number	:	386-752-2480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	06/16/2022

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